Healthcare Provider Details

I. General information

NPI: 1114855475
Provider Name (Legal Business Name): MIDWEST COMMUNITY CARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2026
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 W BIG BEAVER ROAD SUITE 2020 M, OFFICE 129
TROY MI
48084-4900
US

IV. Provider business mailing address

755 W BIG BEAVER ROAD SUITE 2020 M, OFFICE 129
TROY MI
48084-4900
US

V. Phone/Fax

Practice location:
  • Phone: 929-398-0682
  • Fax:
Mailing address:
  • Phone: 929-398-0682
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: FAISAL FARHANA
Title or Position: DIRECTOR
Credential:
Phone: 929-398-0682